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The Effect of Emergency Department Crowding on Patient Outcomes

Background: An extreme excess of patients exceeding the capacity of emergency departments (EDs) to provide care is an emerging threat to patient safety and health systems worldwide.

Aim: The purpose of this literature review was to investigate the effects of emergency department crowding on patients outcome.

Method and Material: A comprehensive search of the medical literature in Pubmed/ MEDLINE database was performed to identify all original articles that were published or available on-line between January 1, 2003, to January 1, 2013, and related to the concepts of ‘‘emergency department’’ and ‘‘crowding’’ or ‘’overcrowding’’.

Results: Of the 1327 studies that were initially retrieved, 484 were excluded because they had no relevance to the topic and 843 after checking for eligibility criteria. From remaining 61 articles, a total of 35 studies were finally included in the review. The three main categories that were constructed based on the studies, were delays in treatment interventions, increased medical errors or adverse events and increased mortality.

Conclusions: The body of literature in aggregate strongly suggests that ED crowding is associated with potential of poorer performance and adverse clinical outcomes, including mortality. Further research is needed to fully understand the precise mechanism through which crowding adversely affect patient care. Policies must also be targeted to adapt of emergency care system in the fluctuation of inputs for better care that translates into better outcomes for patients visiting EDs..

Author(s): Filippatos George and Karasi Evridiki

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